Centreville High

School Bands Student &

Parent Acknowledgement Page

Students name: ______________________________

**Please return this signature page by Friday, 9/9/16

I have read and understand the following documents, policies, and procedures:

_____ Summary of Course Description and Policies

_____ Performance Attire description

_____ Required rehearsal and performance Calendar for the entire school year (Blackboard)

_____ Fee structure document. Please return payment by the due date (9/16/16). Please write
your childs LEGAL name in the memo line

_____ FCPS Consent to Share Information for Benefits for Other Programs form (on FCPS site)
I understand that if my student is eligible for the federal Free and Reduced-Price Meals
program, I must sign and return this form in order for my student to receive reduced or
waived feed for band class.

** Instrument Rental Contract (if applicable) is due no later than 9/16/16

___________________________________ _________________
Student signature Date

I will work to the best of my ability to help my student meet the above requirements of the course.
I will contact the teacher if there are any questions, problems, or concerns.

__________________________________ _________________
Parent/guardian signature Date